| Summary: | 碩士 === 國立臺北大學 === 法律學系一般生組 === 105 === Since Judicial Yuan Interpretation No.533 has been revealed , ”the insurance contracts between the Contracted Medical Care Institutions and National Health Insurance Administration Ministry of Health and Welfare （NHI）”was generally deemed as administrative contract. However, the legal relationship between the Contracted Medical Care Institutions and NHI still needs to be further clarified. Therefore, this study is intended to explain the legal relationship between the Contracted Medical Care Institutions and NHI by examining cases which involve NHI’s regulation of the Contracted Medical Care Institutions and false declaration of medical expenses.
“The Insurance Contract between the Contracted Medical Care Institutions and NHI ”is the formal standard between NHI and the Contracted Medical Care Institutions . Yet the terms mostly reaffirm the regulations , which reveals the characteristic of “the Insurance Contract between the Contracted Medical Care Institutions and NHI ”and this characteristic is also known as“the normative contract”（“Normativvertrag ”in German）. The normative contract is characterized as“the Insurance Contract between the Contracted Medical Care Institutions and NHI ”, so does the contract of mandate. “The Insurance Contract between the Contracted Medical Care Institutions and NHI ” is classified to administrative contracts . However ,under the influence of the principle of rule by law ,there is no application to the principle of freedom of contract to “the Insurance Contract between the Contracted Medical Care Institutions and NHI ”.
Since the type of Medical Care Institutions and doctors’ behaviors have been regulated by relating health law, the legal relationship between the Contracted Medical Care Institutions and NHI is under dual administration. As previously stated, the terms of “the Insurance Contract between the Contracted Medical Care Institutions and NHI ”are subject to NHI and the Contracted Medical Care Institutions, which is necessarily to enquire the range of “the relating regulations ”and the role that doctors play in the relationship between the Contracted Medical Care Institutions and NHI.
The terms of “the Insurance Contract between the Contracted Medical Care Institutions and NHI ” mostly reaffirming the regulations will not alter the legal native of administrative acts performed by NHI. Each administrative act’s legal native should be separately observed.
After discussing the regulations and the administrative acts performed by NHI, this study will continue to discuss on cases which NHI regulating the contracted medical care institution involving false declaration of medical expense, including gathering evidences, interpretations and applications to the regulations, the relating liabilities and its cumulative effect, and the usual claim filing in the suite. In short, this study desperately clarifies the administrative relationship between NHI and the Contracted Medical Care Institutions.
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